Dados do Trabalho

Título

An illustrative phenotype in anti-MOG associated meningoencephalitis

RESUMO

Case report: A 23-year-old male admitted to our hospital with a headache three weeks after his first dose of vaccination against SARS-CoV-2. One week later, he was admitted due to generalized tonic-clonic seizure, evolving with fever, encephalopathy, bilateral low visual acuity and left hemiparesis. Cerebrospinal fluid (CSF) examination showed pleocytosis (lymphocyte predominant) and elevated protein. Broad-spectrum antimicrobials were promptly initiated, but specific exams for infectious diseases were all negative. His first brain magnetic resonance imaging (MRI) was normal. He had mental status worsening and a new MRI demonstrated cortical and subcortical hyperintensity on the T2-weighted image and FLAIR in the right frontotemporal region. He was readmitted to our hospital, where the antimicrobial treatment was suspended and methylprednisolone and plasma exchange were prescribed, considering the possibility of a demyelinating disorder, with optimal response. A new MRI showed frontotemporal cortical and subcortical lesions bilaterally, in the thalamus and brainstem, with areas of subcortical enhancement. Oligoclonal bands in CSF and anti- myelin oligodendrocyte glycoprotein (MOG) in the serum were positive. Discussion: MOG antibody-associated disease (MOGAD) is an inflammatory disease of the central nervous system with many described phenotypes still in characterization, including meningoencephalitis. Conclusion: We presented a case of MOGAD with meningeal involvement, which occurs in less than 10% of adults. Vaccination may be a risk factor for MOGAD attacks. Some findings of our patient are more specific for MOGAD, like leptomeningeal and thalamic involvement.

Palavras Chave

Anti-MOG, meningoencephalitis, encephalitis, autoimmune, MOGAD

Área

Neuroimunologia